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Boldly Using Technology to Implement and Change the Culture around Routine HIV Screening Sin

Vergüenza (Without Shame) Angel Rosario, Clinic Testing

Supervisor

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Topics • AltaMed Health Services Corporation • Electronic Health Record Development • HIV Training Modules • Sin Verguenza

AltaMed has delivered quality care to the underserved communities of Southern California for more than 40

years. Designated by the Joint Commission as a Primary Care Medical Home (PCMH), AltaMed prides itself in the

quality of its care delivered by its premier health care professionals. AltaMed serves the entire family with:

1) primary medical care 2) dental clinics 3) senior long-term care services 4) delivers disease management programs 5) health education 6) youth services, 7) specialty HIV/AIDS care for over 20 years 8) substance abuse treatment.

One of nation’s largest FQHC’s, with wrap-around IPA PCMH certified by TJC and NCQA 73% earn less than $44,700/year for a family of four Take all insurance types; 27% have no insurance 81% of our patients are Latino 1,900 employees across 43 sites 125,000 patients served; 930,000 annual visits 140 providers, mid-level practitioners 600 contracted specialists

Routine Testing Goals

2006 CDC Revised Recommendations Guidelines

For those aged 13-64:

Gilead Funded 2010

Los Angeles Three Pilot Sites: •East LA Commerce •El Monte •Pico Rivera

8,013 patients tested at pilot sites from January 2010-September 2011 •121,310 total eligible patients seen at AltaMed (all clinic sites) from January 2010 to September 2011, representing a penetration rate of 6.6%

28 HIV positive clients were identified

24 of the 28 (86%) testing positive were male, 4 were female. ***Lab Default

The Pilot

A Taste of Technology

This is all fine print for the graph above: Denominator: Patient must be 18 years old and above. Patient must not have undergone the screening in the past 12 months (1 year).

Numerator: Patient must be 18 and above that have received HIV Screening in the month selected. CPT Code: (86703, 8670392, NG083875, 19728)

Implementation of HIV Screen Lab Default

• In OC, from 10/1/2011 to 12/31/2012, 11,010 HIV screens performed and a total of 10 HIV+ individuals (newly identified and re-identified and linked into care)

• From 1/1/2013 to present, • Allowed us to focus efforts on routine

screening by developing infrastructure, visibility, and internal support

• Develop routine screening as a campaign

Into OC

What we had:

Internal Barriers to Testing

• Changing the culture of AltaMed: – Support from senior leadership – Staff Support

• (Clinic workflows, lack of comfort with procedures)

– Staff training – Lack of patient education on routine testing policies – Lack of patient buy-in for routine testing

Using Technology: AltaMed University

• A learning management system (LMS) where staff gain access to training videos for personal/professional development and/or mandatory compliance trainings (occupational hazards, customer service, HIPAA, etc.)

Video Training Modules

Using Hollywood:

Mandatory Training using AltaMed U

• Senior Leadership support for routine HIV Screening

• All clinical staff required to complete the entire set of HIV training by end of Q4 (October 1, 2012- December, 32, 2012)

• Over 700 clinical staff completed modules

The Pop-up Alert

Streamlining Processes: Continued EHR Development

Testing Alert Promotion

Testing Alert Promotion

Sin Verguenza

• Develop a culturally competent education tool to: – Disseminate HIV Prevention messages in an innovative,

non traditional, accessible manner – Engage communities in conversations about HIV – Educate on CDCs recommendations for routine

screening – Develop a script from the stories of our HIV+ patients

Increase HIV testing at our clinics

Sin Verguenza

Sin Verguenza

• Developed an • Work with production company and casting

agency to hire REAL actors • Release Dates:

– World AIDS Day and bi-weekly release of webisodes on YouTube thereafter

• Worked with CSULB to develop an online survey linked to YouTube page

• As of April 2013: 120,000 > views

Sin Verguenza

Current/Future Projects:

• “Together We Test” Campaign

• Preventions programs around Sin Verguenza

• Patient Narratives • Focus Groups • Documentary Short

Contact Information

Angel Rosario Clinic Testing Supervisor AltaMed Health Services Corporation arosario@altamed.org 714-500-0348